Diagnostic approach to the patient with a chronic diarrheal disorder.
Chronic diarrhea is a common problem facing the practitioner of medicine. Despite impressive advances in diagnostic technology, many patients continue to have chronic diarrhea without a firm diagnosis being established. Most important, the history and physical examination are often perfunctory and the patient undergoes a number of contrast and imaging studies, endoscopic procedures, and laboratory investigations which may still be non-diagnostic. In all patients with chronic diarrhea, which I will arbitrarily define as diarrhea that has persisted over at least 2 months, there is a need for a careful orderly approach to the differential diagnosis. In this paper I will detail a method that I have used in evaluating such patients. The method emphasizes a careful history and physical examination, judicious and sequential use of laboratory investigations, contrast studies, and endoscopic procedures, and calls attention to special situations where more detailed investigations are required. I have found that unless I go through this detailed diagnostic approach, I will miss disorders that can be readily diagnosed and, more importantly, such patients may not be given appropriate treatment.
Greenberger
N J
NJ
Department of Medicine, University of Kansas Medical Center, School of Medicine, Kansas City.
D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D001647:Bile Acids and Salts / Q000009:adverse effects; D002400:Cathartics / Q000506:poisoning; D002908:Chronic Disease; D002985:Clinical Protocols; D003093:Colitis, Ulcerative / Q000150:complications; D003952:Diagnostic Imaging; D003967:Diarrhea / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008286:Malabsorption Syndromes / Q000150:complications; D008487:Medical History Taking; D008875:Middle Aged; D010808:Physical Examination
D000900:Anti-Bacterial Agents; D001647:Bile Acids and Salts; D002400:Cathartics